Provider Demographics
NPI:1386934248
Name:SHAH MEDICAL CENTER LLC
Entity type:Organization
Organization Name:SHAH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:AKSAR
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-924-2424
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0671
Mailing Address - Country:US
Mailing Address - Phone:580-924-2424
Mailing Address - Fax:580-924-2425
Practice Address - Street 1:720 BRYAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7032
Practice Address - Country:US
Practice Address - Phone:580-924-2424
Practice Address - Fax:580-924-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty